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Mean serum D-dimer level to predict in-hospital mortality in COVID-19
Mert İlker Hayıroğlu1, Vedat Çiçek2, Şahhan Kılıç2
1Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Insights
Elevated mean D-dimer levels during hospitalization for coronavirus disease-2019 (COVID-19) significantly predict in-hospital mortality. Closer patient monitoring and aggressive treatment may be warranted for those with higher mean D-dimer readings.
Area of Science:
- Medical research
- Clinical diagnostics
- Infectious disease epidemiology
Background:
- The prognostic impact of early hospitalization mean serum D-dimer levels in COVID-19 patients remains unclear.
- D-dimer, a marker of coagulation activation, is frequently elevated in severe COVID-19.
Purpose of the Study:
- To investigate the association between mean D-dimer levels within the first five days of hospitalization and in-hospital mortality in COVID-19 patients.
- To determine if mean D-dimer can serve as a prognostic biomarker for COVID-19 outcomes.
Main Methods:
- An observational retrospective study involving 240 adult COVID-19 patients.
- Mean D-dimer calculated from days 1, 3, and 5 of hospitalization.
- Patients stratified into tertiles based on mean D-dimer; mortality rates compared. Receiver operating curve (ROC) analysis performed.
Main Results:
- After adjusting for baseline variables, patients in the highest tertile of mean D-dimer had a 4.2-fold increased hazard ratio for in-hospital mortality (OR 4.2; p<0.001).
- ROC analysis identified an optimal cutoff value of 779 μg/L for mean D-dimer to predict in-hospital mortality, with 77% sensitivity and 83% specificity (AUC 0.87; p<0.001).
Conclusions:
- Higher mean D-dimer levels in hospitalized COVID-19 patients are a significant predictor of in-hospital mortality.
- Patients with elevated mean D-dimer warrant closer monitoring and consideration for aggressive treatment strategies, including biologic agents or convalescent plasma.
Objective:
The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five days of hospitalization of the patients, has not been elucidated. This study aimed to evaluate the effect of mean D-dimer level about in-hospital mortality in patients hospitalized due to coronavirus disease-2019 (COVID-19) infection.
Methods:
In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer [D-dimerfirst day+D-dimerthird day+D-dimerfifth day)/3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve analysis.
Results:
After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with 4.2-fold hazard ratio of in-hospital mortality (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.8-20.1, p<0.001). A receiver-operating curve analysis revealed that the optimal cutoff value of the mean D-dimer to predict in-hospital mortality was 779 μg/L with 77% sensitivity and 83% specificity (area under the curve [AUC] 0.87; 95%CI 0.81-0.94; p<0.001).
Conclusion:
Patients with a higher mean D-dimer level should be followed-up more closely as they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma.
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